Mod 8: Sclerotherapy, Prolotherapy, & Lubricants Flashcards
What is Sclerotherapy?
Sclerotherapy involves the injection of a solution (usually salty) into a tissue such as vein or nerve.
Causes irritation in the lining of blood vessels, lymph vessels and nerves.
Leading to blood in vessels clotting, and to desiccate
Sclerotherapy remains the primary treatment for small vessel varicose disease of the foot and lower extremity but what do this include?
Telangiectasias
Venulectasias
Reticular Ectasia’s
What are Telangiectasias?
Red
Flat vessels
1mm or smaller in diameter.
What are Venulectasias?
Blue
Sometime distended above the skin
2mm or smaller in diameter
What are Reticular Ectasias?
Reticular veins
Cyanotic Hue
2-4mm in diameter
Which vessels respond best to Sclerotherapy, LARGE or SMALL?
SMALL
What are the major indications for using Sclerotherapy?
Improve cosmetic appearance
Reduce associated symptoms such as burning and pain.
To Rx remnant tributaries after endovenous laser ablation of Saph or truncal vessel.
Contra-indications to Sclerotherapy are?
Pregnancy Thrombophlebitis Pulmonary emboli Hypercoagulable states Allergy to Sclerosing agent
Which Diagnostic method is used to diagnose veinous disease?
Duplex Ultrasonography
Visual Sclerotherapy is what?
Injections without the use of Ultrasonography
Duplex guided Sclerotherapy (endovenous chemical ablation) is what?
Injection guided with Duplex Ultrasonography
The most common agents used in Sclerotherapy are what?
Hypertonic Saline (23.4%)
Sodium Tetradecyl Sulphate
Polidocanol
Chromated Glycerin
Should Sclerotherapy start with proximal or distal vessels?
Proximal: Varicose veins
Reticular veins
Talengeictasias
Ambulation should begin how soon after injection and compression bandage is applied?
IMMEDIATELY
What gauge needle is best used for Sclerotherapy?
30g bevel up to gauge depth
If severe pain presents this could indicate what? and how can this be alleviated?
Extravasation of WBC
Injecting the site with Sodium Chloride or LA will help dilute the Sclerosant.
The areas at highest risk of ulceration are where?
Pretibial
Ankle
What are the usual injection sizes? and at what interval spacing?
0.1-0.4ml
2-3cm intervals
Graduated compression stocking (class 1) of 20-30mmHg should be worn for the 1st night, TRUE or FALSE? then for how long after Rx?
TRUE
1-3 weeks depending on vessel size
Lower extremity exercises are to be performed immediately after Sclerotherapy however how long should aggravated exercise be avoided for?
4 weeks
Compression garments reduce the incidence of transient hyperpigmentation and edema, TRUE or FALSE?
TRUE
Superficial Thrombophlebitis is rare but can be treated with?
Compression
NSAIDS
What is a possible cause of tissue necrosis?
Extravasation
Injection into an arteriole
Massage and topical 2% nitroglycerin ointment are Rx for what?
Shiney white blanching associated with injection into an arteriole or spasm
Describe alcohol ablation of a mortons neuroma?
Ethanol is injected around the Nerve causing neurolysis, through dehydration, necrosis, and precipitation of protoplasm
What is the preparation of 4% ethanol sclerosis therapy?
2ml 4% absolute ethanol alcohol
48mls of 2% Xylocaine with epinephrine 1:100,000
1ml of this mix is injected for 5-7 weeks
Prolotherapy works by?
Claims to strengthen inadequate ligaments, tendons, and produce cartilage by injecting them with an irritant to induce fibroblastic hyperplasia.
Use of steroids is con current to Prolotherapy because of what?
Prolotherapy induces inflammation and steriods reduce inflammation.
Prolotherapy preparations include?
P2G (phenol, glucose, glycerin)
Dextrose
OA can now be Rx by intra-articular injection of a lubricant, what is this know as?
Viscosupplementation
Most commonly used agent for viscosupplementation is?
Hyaluronic acid (Hyalgan, Synvisc)
HYALGAN and SYNVISC are used in injections to a single joint and come in pre filled single use syringes but what is their frequency?
HYALGAN - 3-5 injections 1 week apart.
SYNVISC - 3 injection 1 week apart.
Injection technique for Lubrican injection is what?
Strict sterile technique (not to use disinfectants containing quanternary amonium)
Use 18-22g needle to draw as much fluid from joint as poss
use different 18-22g needle to inject Viscosupplement.
*Steroids or LA should not be mixed with viscosupplement to prevent dilution
LA can be used to numb area of injection
Care should be taken to avoid IV injection of lubricants, how might this present?
Rashes Hives Itching Muscle pain/cramps Flushing/swelling of face Tachycardia Nausea Dizziness Fever Chills Headache Difficulty breathing Swelling arms/legs Rare cases decreased platelet level
Following Lubricant injection post op information should include?
Information about possible side effects: Pain, swelling, restricted motion.
If necc - Rest, Ice, Heat, NSAIDS
Avoid High impact activity for 48hrs
